Daylight saving time is approaching again. At first glance, it might seem enough to just remember to spring forward. But do you realize daylight saving time is one of the grandest social engineering experiments in America? Almost the entire country moves their schedule up one hour. Every meeting, romantic dinner, and heart transplant occurs one hour later. Every business, court appointment and movie showing is one hour later. In virtual lockstep, ...

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As a nation, we are constantly monitoring and appraising the economy and our financial health.  We gather a tremendous amount of information to assess this. The Census Bureau randomly selects 60,000 households each month, unleashing a swarm of 2,000 field representatives to track down the selected participants and assess their employment status. The Bureau of Labor Statistics surveys 500,000 businesses to estimate job creation.  Approximately 5,000 “consumers” are surveyed ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 43-year-old man is evaluated in the hospital for severe abdominal pain of 2 days' duration. He is otherwise healthy except for the recent finding of pancytopenia. Family history is noncontributory. His only medication is a daily multivitamin. Following a physical exam and lab results, what test is most likely to establish ...

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The media headlines attached to the major medical news story of the past week might have been: "Shocking but true: Nearly 1 in 10 US children under the age of 5 is obese!" Had that been the headline, it would indeed have been every bit as true as it is shocking. And the really shocking part is: that's the good news! Hold that thought, please. Some years ago, at the prompting ...

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Vaccine coverage rates, overall, remain very strong in the USA. Well over 90% of kids are well-vaccinated, and the rates of vaccine-preventable diseases remains very low. Newer vaccines have proven especially safe and effective, including immunizations against severe diarrheal illness and cancers of the cervix and throat. In many ways, we are staying ahead in our battle against vaccine-preventable disease. Yet: there are still pockets of intense resistance to vaccines, ...

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When it comes to high blood pressure treatment in the elderly, the plot continues to thicken. Last December, a minor controversy erupted when the JNC hypertension guidelines proposed a higher blood pressure (BP) treatment target (150/90) for adults aged 60+. And now this month, a study in JAMA Internal Medicine reports that over 3 years, among a cohort of 4961 community-dwelling Medicare patients aged 70+ and diagnosed with hypertension, those on blood pressure medication ...

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Physicians and patients collaborate to treat symptoms. This is not newsworthy and even sounds appropriate. Isn’t that what doctors are trained to do? It is but I’m not sure this should be a central focus of our healing mission. Treating a symptom is not the same as treating a disease. For example, if an individual is having abdominal discomfort, pain medicine should not be the first responder, even if this would ...

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I just didn’t like the looks of him. It was the way he was breathing. I counted for a full minute: 24 breaths. (The ER would later document 40.) No accessory muscle use. Not even much coughing. He didn’t look overly anxious or uncomfortable, though he said he couldn’t breathe. No fever. No wheezing or other abnormal lung sounds on exam. No leg swelling or tenderness. Pulse ox 95% on room air (97% in ...

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Mrs. Sandra Jackson knew that she was no Warren Buffet. She knew that she was no Bill Gates. Instead, Mrs. Jackson knew that she worked two jobs, 7 days a week to support her family. So, she hid her breast condition for a better time, another day. She would ask herself, which was more important: going to a doctor or buying her children dinner? For a true mother, the answer ...

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A recent article in the New Republic, provocatively titled “ADHD Does Not Exist,” starts out well enough. The author, a psychiatrist with “over 50 years experience” points to the fact that ADHD describes a collection of symptoms, rather than their underlying cause. Using stimulants to control these symptoms, he argues, is analogous to prescribing pain medication for cardiac chest pain rather than addressing the underlying circulatory problem. But my ...

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